242079 Integrated management of an ongoing tuberculosis outbreak in a U.S. born homeless population in Indianapolis, IN

Wednesday, November 2, 2011

Eva Muloma, MD , Marion County Public Health Department, Indiana University School of Medicine, Infectious Disease, Indianapolis, IN
Monica Heltz, RN, MPH , TB Program, Marion County Public Health Department, Indianapolis, IN
Juanita Brand, RN, EdD, MSN , Marion County Public Health Department, Ball State University School of Nursing, Indianapolis, IN
Virginia A. Caine, MD , Public Health Administration, Marion County Public Health Department, Indianapolis, IN
Background: In 2009, the TB case rate in foreign-born persons was approximately 11 times that of U.S. born persons. In contrast, that same year an outbreak of Mycobacterium tuberculosis was identified among U.S. born homeless in Indianapolis, Indiana. All matched a unique genotype, IN0074. By the end of 2010, 20 active TB cases had matched IN0074. Methods: Challenges to controlling TB among the chronically homeless are widely recognized. Case management is often complicated by client factors such as: use of congregate settings; high incidence of substance abuse and mental illness; lack of a medical home; and general mistrust of authority or government. Traditional TB control strategies, while important, may require integration of population specific measures for successful treatment outcomes. The need for flexibility, creativity and sensitivity are paramount. Findings: We will discuss integrated, non-traditional measures being applied in the management of an ongoing TB outbreak among the homeless. Our success includes a 100% treatment completion for eligible TB cases. The focus will be on innovative laboratory, medical and collaborative measures, as well as the success and challenges encountered. Topics discussed will include: the role of genotyping; Interferon Gamma Release Assays (IGRAs); mechanisms for information sharing with community and healthcare partners; Directly Observed Preventative Therapy (DOPT); and short-course therapy for latent TB infection. We will highlight the critical role of positive client/provider relationships when working with vulnerable homeless populations.

Learning Areas:
Administer health education strategies, interventions and programs
Basic medical science applied in public health
Program planning
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related nursing

Learning Objectives:
1. Discuss three challenges to managing a tuberculosis outbreak in an urban homeless population. 2. Describe six innovative techniques appropriate to implementation of a management strategy for a TB outbreak in among the homeless. 3. Define a crucial factor that is integral to an effective evidenced based program when working with a homeless population.

Keywords: TB, Homeless Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee the Tuberculosis Program at a large local health department, and have been overseeing outbreak response efforts in the homeless population in my county.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.